Academic journal article International Perspectives on Sexual and Reproductive Health

The Influence of Wives' and Husbands' Education Levels on Contraceptive Method Choice in Nepal, 1996-2006

Academic journal article International Perspectives on Sexual and Reproductive Health

The Influence of Wives' and Husbands' Education Levels on Contraceptive Method Choice in Nepal, 1996-2006

Article excerpt

CONTEXT: The association between education level and fertility, contraceptive behavior and method choice has been extensively researched, but little is known about how the education differential between husbands and wives in Nepal may influence the choice of specific methods.

METHODS: Data collected from currently married, nonpregnant women aged 15-49 in the Nepal Demographic and Health Surveys of 1996, 2001 and 2006 were analyzed to identify shifts in the education levels of husbands and wives and the influence of those shifts on couples' current contraceptive method use over the past decade. Multinomial logistic regression models assessed associations between method choice and each partners education level, the education differential between partners and a combined education measure.

RESULTS: Although the wife's education level was associated with the type of method used by the couple, the husband's education level had more influence on the use of male sterilization and condoms. For example, men with any secondary or higher education were more likely than those with none to rely on either of these methods (relative risk ratios, 1.6-2.1). Furthermore, couples in which the husband had at least six more years of education than the wife also showed increased reliance on male sterilization or condoms (1.6-1.8). Differences in the use of any method of family planning by education level have narrowed considerably in the past decade, although differentials remain in the use of some methods.

CONCLUSION: A better understanding of how wives' and husbands' relative educational attainment affects decisions on their contraceptive choices is needed, particularly when both education levels and contraceptive use are increasing.

International Perspectives on Sexual and Reproductive Health, 2009, 35(4): 176-185


Over the past three decades, substantial changes have occurred in fertility, family planning and contraceptive choice in Nepal. In the mid-1970s, fertility peaked at six births per woman, and only 3% of married women were using any Form of modern birth control. (1) Fertility declined to 4.1 births per woman by 2001, and to 3.1 by 2006. Moreover, 26% of married women were using a modern contraceptive method by 1996, and this proportion rose to 44% by 2006.

There have also been significant shifts in the contraceptive method mix in Nepal. When the country began its family planning program in 1968, sterilization--both male and female--was emphasized by the government in an effort to reduce the fertility rate in the largely rural and illiterate population. Male sterilization was the predominant method in the early years of the program, but it was soon replaced by female sterilization. (2) Although the latter has continued to be the most common method, the use of reversible methods has gradually increased. Injectable use, in particular, has increased steadily since 1991, and rose sharply between 1996 and 2001. Use of the pill and condoms has also increased since 2001.

Most family planning research in Nepal has focused on the dynamics of contraceptive use and nonuse, (3-9) in part because overall use remains low and unmet need for family planning is high. The dominant goal among policymakers has been to reduce fertility levels by increasing contraceptive prevalence. Much less attention has been given to method choice, although a few recent studies have explored this issue. (8-10-13) One study examined factors that influence the use of reversible versus permanent methods of birth control in the Chitwan district of Nepal. (8) Another examined joint husband-wife involvement in contraceptive decision making in two rural population clusters; it found that unequal power relationships led to the husband's domination in decisions regarding whether to use contraceptives, which method to choose and whether to continue use. (11)

A study that used data from the 2001 Nepal Demographic and Health Survey (DHS) examined men's contraceptive choices and found that the number and sex of their children were important factors in men's use of permanent methods. …

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